Sleep in Adolescents - Delayed Sleep Phase Syndrome
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In most cases, the sleeping hours of young people seem abnormal to the rest of the family. Many adolescent people, in the age of 15-20 years (even up to thirty years for some people) prefer to stay awake in the night for long hours and then struggle to wake up early. This hampers their academic or professional goals.

These youngsters are usually described as inactive and lazy. However, in most cases, this problem has physical causes and not behavioral ones.

Often young people visit the clinic to cure a problem where the sleep status is normal but there is impairment in the sleep time. In this article, we will talk about the problem as well as the treatment for the "Delayed Sleep Phase Syndrome.”

Biological ClockBiological Clock

Before discussing the problem, we have to know what a biological clock is.

Every human being has been created with a biological clock that instructs the body about the time to sleep, to eat, react to variations in hormone levels, and body temperature, etc.

Circadian Rhythms refer to the biological and physiological variations that follow the circadian cycle. The biological clock is responsible for long hours of sleep of the children.

This process differs for some individuals entering adolescent period, as they do not get sleep till 11 p.m. or even after that.

The desire of some people to stay awake for studying during the night or for outings with relatives or friends, etc may aggravate the problem.

Simply put, the biological clock is the body’s ability to get sleep at a specific hour (usually at night) and to wake up at a specified time (usually daytime).

Many external factors affect the regularity of the body's circadian rhythms or the biological clock; light and noise being the key ones. These are accompanied with alterations in bodily functions that could be more effective during the day than the night.

The sleep hormone rate (melatonin) is increased during night and decreased during day, but work in contrary for people with this disorder.

The exposure to light is responsible for reduction of level of the sleep hormone in the blood. This hormone is secreted from the pineal gland in the brain that is connected to the optic nerve. Hence, a long exposure to bright light causes reduction in hormone secretion.

The concepts of light therapy are based on this mechanism.


Research suggests that in order to have a good level of concentration, young people need to have 9 hours of sleep per day. However, the reality is quite different. An American survey presented that more than 25% of the adolescent sleep for 5-6 hours per day, because they feel studying, spending time with friends or playing video games late in the night is more important than sleeping early.

These reasons cause a severe drop in sleeping hours, and if the behavior persists, it can lead to a chronic problem. A decreasing in sleep causes lack of concentration, adversely affect academics, as well as causes mood and behavioral disorders, affecting their academic achievements and limiting their ambitions for success and passion for their work.

It is often noticed that people do not take adequate sleep during the week and then oversleep in the weekend to compensate. Thus, the person’s biological clock makes him sleep until late mornings and stay awake at night causing a persistent problem.

We see parents asking their children with delayed sleep syndrome to get to bed early, which serves no purpose, as they remain awake in the bed for a long time, unable to sleep.

Sleep in Adolecent

How to help a patient?

There is a successful therapy for this disorder and several young people have responded well to the treatment. The success of the therapies requires three things:

  1. Complete compliance to treatment system.
  2. Strong will power of the patient.
  3. Help from family and friends.


  • Light therapy: As mentioned earlier, light is the basic factor that defines the biological clock in the body. So it is advised that the patient stays under strong light at waking up for an hour per day. This does not mean that one must spend time in the heat or sun; instead, one should sit beside a window and use the sunlight as a cure.

It is the basic treatment and is supported by various scientific researches. Patient can use this time to study or read under sunlight. We also advice the patients to have a dim light and comfortable ambience one hour or two before sleep.

  • Fixed sleeping and waking up times: This is one of the most difficult stages during the treatment, for it is very important to follow a fixed sleep and waking up schedule. Some patients follow this system during the weekdays but violate it during the weekends because of “social commitments.” This disrupts the course of the treatment.
  • Changing behaviors: It is very important for the patient to follow a fixed routine including food and physical exercise time. One should also relax one or two hours before sleep and avoid tasks that activate and motivate the brain one hour before sleep. For example, working on a computer, phone conversations, or video games. The television must also be avoided as far as possible.
  • Daytime naps: Many patients compensate the lack of night sleep with long naps during the daytime. This worsens the problem and causes insomnia. If there is a dire need for a nap, then it should not exceed half an hour. This requires a strong will power and family’s help.
  • Stimulants: It is a necessary to avoid all kinds of stimulants during the afternoons, as its effect may last until late night and cause insomnia.
  • Changing the sleep time: To alter the sleep timing is one of the major difficulties that a patient suffers at the onset of the treatment. We understand that, the patient cannot be forced to sleep early at in the beginning, as the effect of the treatment takes time.

We recommend that, the patient's family must support and allow him to sleep at the suitable times and relentlessly wake him up early, irrespective of the sleep hours. They can do this by setting the clocks ahead by 10-15 minute per night until the patient is habituated.


Ahmed BaHammam, FACP, FCCP
Professor of Medicine
Director, University Sleep Disorders Center
College ofMedicine, King Saud University